Category Archives: The Scary Real World

Today is another day on which a celebrity reminds us all that depression is a genuinely life-threatening disease. Robin Williams’ apparent suicide has shocked the world. Of course it has, just as any premature death ought to. But as with many deaths from suicide or related to addiction or general psychological issues, particularly with celebrities, there’s a minority of people who don’t quite understand. “What did he have to be depressed about?” people ask. “He had money, fame, respect… what’s not to love about life if you’re Robin Williams?”

It always bears repeating: depression is not a selective illness. There are compounding factors, of course: poverty, childhood trauma etc. But depression can come from anywhere and attack anyone. It’s important that people understand this, if the ongoing stigma is to subside.

Still, both Rhodes’ column and Fry’s comments regarding it left me a little uncomfortable. It’s not that the core message is troublesome. Far from it. The more times we can stand on a podium and remind people to talk about depression, to learn about it, to educate themselves and support those who are suffering from it, the better. In its introduction, though, Rhodes’ piece quite explicitly draws a distinction between severe and mild forms of depression, and his use of language carries a nasty undertone of sneering at those whose problems aren’t “real”.

Let’s be absolutely clear about something: nobody’s problems are trivial. Ever. If problems become trivial, they’re not problems; they’re minor inconveniences. It’s the reason I always found it baffling to see some people with self-harm problems berate others for “only doing it as a cry for help.” (Have you actually stopped to consider that phrase? “A cry for help”? A cry for help – as if someone crying for help is somehow worthy of sneers and derision, instead of – y’know – help.) It’s the reason that “well, some people are starving in Africa” is never an appropriate response to anything, and why the “first world problems” meme continues to irk me. And, placed in the context of a real, life-destroying illness, this attitude takes on a particularly scary face.

It’s scary because depression grows. If left unchecked, it bubbles and simmers inside you, barely noticeable at first, then a little more noticeable, before eventually you realise it’s taken over everything. You realise that the thing you loved doing a year ago now seems miserable to you, and you half-recall finding it mildly tedious six months back. You note that the constant reminders to yourself, that it will seem better after a good night’s sleep, aren’t something you can cling onto all that well when they never turn out to be true. Slowly, but at the same time very suddenly, you realise it’s sucked the life out of you.

Temporary illnesses are only ever temporary once they’ve stopped. Until then they’re constant, and it can’t always be easy to predict which way things will go. Indeed, depression itself can be temporary. Generally speaking, a period of two weeks of symptoms that match, with no obvious or typical trigger, is enough for it to be considered an episode of depression. For some people, that two weeks is the only time they’ll ever struggle with it. For others, it will be years, perhaps decades, of continual pain and suffering. For many of us it’s somewhere in the middle: a series of shorter episodes, a few days or weeks at a time, thankfully broken up by happier times. For those of us in the latter position, it’s something we learn to live with, and to not let consume us, but make no mistake: while we thank our lucky stars our situation isn’t worse, we still consider it a very “real” thing to live with.

Well-intentioned or not, I struggle to not be offended by Rhodes’ use of language. It “seems” that a lot of people are depressed, but “of course” they’re not. They’re just “claiming” to be depressed. They’re doing so for a variety of ludicrous reasons, such as being bought the “wrong-coloured iThing” – and the misuse of the term is diluting the perceived seriousness of “real” depression. We know that our use of language, to an extent, colours the way people around us see the world, so it’s an important topic to consider. But in raising this argument, Rhodes himself falls prey to temptation toward hyperbolic language, and leaves a gaping hole wide open in a genuinely problematic way.

The fact is that, like most illnesses, depression has different severities and, like most mental illnesses, is really a convenient catch-all term that describes a spectrum of psychological conditions. Practitioners will diagnose anything from “mild” to “severe” or “clinical” depression, and they use a complex (though not flawless) system to make these diagnoses, based on points accumulated from a survey of symptoms and the length of time those symptoms have been experienced. James Rhodes, meanwhile, asserts that depression should be considered separately from a case of “temporary low mood” that can be treated with talking therapy, citalopram and patience.

This is an odd thing to assert. What Rhodes is saying here is that psychological issues that require fairly significant treatment still aren’t proper depression unless… well, unless what? Unless you feel suicidal? Unless you self-injure? What are the criteria upon which Rhodes feels one should be allowed to “claim to be depressed”?

In his very own introduction, Rhodes loses sight of what becomes the very admirable point of his article: that it is important to listen to those with depression, to understand the condition they live with, and to talk openly and in confidence about an illness that has long been stigmatised. When you have, within the opening three paragraphs, already alienated a range of people with that very condition, there’s a problem. It’s counter to everything he goes onto argue.

The truth is, while it might be important to differentiate between severe and mild depression in terms of treatment, it’s not even slightly relevant to the wider discussion of the topic. People who catch their malignant mole before it starts to spread don’t steal the attention away from those with Stage IV lung cancer. People having a moan about the cold they caught aren’t damaging the world’s attempts to quell the Ebola outbreak. Selecting our language carefully is important, but there is a huge distinction between trivialising a word and using it in a way that feels appropriate to a given situation.

Do you feel like you’re depressed? Use the word. Go nuts. Shout it from the rooftops and help people to understand. People should be able to feel more comfortable talking about the illnesses they live with; in the world of mental health, it’s vital that we move in this direction. Of course it’s not cool to commandeer this sort of language to talk about a minor snafu you’ve had to deal with, just as it’s problematic to talk about how the price of your Sainsbury’s shop “raped” your wallet or whatever. But please, don’t be put off talking about your life because other people’s problems are perceived as worse than yours. These things can grow, and you’d be damn well better off acknowledging them early, before they start to spread.

Oh heavens, and then I didn’t follow up again for like six months. That’s terrible.

Anyway, basically, after a month or two of waiting, my MRI test results came back completely fine.

My knee still hurt for a while afterwards but gradually, over the months, the pain has gone away entirely.

A mystery, basically. Doctor said knees are funny things. Sometimes they just fuck up for a while for no real reason.

So that is the end of the story. It was really quite easy and stress-free to get it seen to, and even though I was in a lot of pain for a while, turned out to be nothing. Moral of the story: if your knee hurts, request an MRI, it’s probably grand.

You know, I said I would follow up after I went to the doctor’s about my knee, and then didn’t, which makes me as bad as one of the people I was trying to avoid. That’s terrible! Except not too bad, because I’m following up now.

I went to the doctor’s. After a lengthy wait, involving a very strange medical cartoon on the television, a nice doctor examined me. Good news, probably! He tugged and pushed and bent and twisted my leg, and concluded that he could see no sign of any ligament damage, which is what his initial concern was. He did notice that it was slightly swollen, even after all this time, although this was after a 20-minute walk to the surgery, which may have had something to do with it.

He wasn’t able to tell me what’s wrong, but he did refer me for an MRI scan, which I’ll be attending next week. Possibilities include a small tear of the meniscus, or “something to do with the fluid in your knee,” whatever that means. The good news is he thinks that surgery would be very unlikely to be needed: knees aren’t good things to surgically mess around with, he said, so unless the problem was causing extreme discomfort/disability, a course of physiotherapy and simple lifestyle changes would almost always be the recommendation.

I have in front of me a 96-page report, published in January. Here is a quote from page 3, the summary:

The overwhelming majority of Council members consider that khat should not be controlled under the Misuse of Drugs
Act 1971

Yesterday, the Home Secretary, Theresa May, announced that khat will be banned, saying that the risks of the plant’s consumption “could have been understated.”

Oh, look. Here we go again.

This is not the first time that the Advisory Council on the Misuse of Drugs has been ignored. In fact, it often seems that the sole purpose of this group of independent doctors, scientists and sociologists is to prepare lengthy reports on what the Government isn’t going to do. The Council was set up to provide Government decision-makers with the necessary expert input in order to calculate the risk potential of both new and existing recreational substances – but the number of times the Government has now rejected its recommendations borders on the ludicrous.

Since the end of the last Labour government, we’ve seen case after case of such dismissals. The Council’s recommendation that cannabis should remain a Class C substance led to – uh – its reclassification to Class B. Its suggestions outlining why psylocibin mushrooms should not be upped to Class A similarly led to exactly the opposite happening. MDMA should be Class B, it said, while more extensive research into mephedrone should be conducted before a ban is considered. The pills remained Class A and the powder was bumped to Class B before a single piece of research into its risk potential had been conducted.

And, of course, former Council Chair, Professor David Nutt, left the Council after publishing a report that suggested alcohol and tobacco were more harmful than ecstasy and cannabis. Nutt says he was sacked – the Government’s angle was always that he resigned. Either way, this is all starting to look a little bit silly: the experts are repeatedly being told, by the non-experts, that they are wrong, that they have misunderstood, that they have underestimated the harms that these drugs can cause. Trouble is, the non-experts have the final say.

Not only does yesterday’s banning of khat seem ridiculous in light of this rich history of rejected reports, it’s also particularly worrying. Khat is a mild stimulant, a plant whose leaves are often chewed, which induces similar effects to a cup of coffee. From it, you can get things like cathinone, and from there you can get things like mephedrone, much like cocaine is derived from the coca plant and heroin from poppies. But in plant form, it’s not all that bad.

This isn’t the issue. The issue is its widespread use, going back hundreds if not thousands of years, in a number of communities around the world. In Somalian, Ethiopian and Yemeni cultures, it’s been a staple of life for as long as people can remember. Just as we love nothing more than a pint of lager on a Friday night, so these communities indulge in a spot of khat. It is the way things are.

It is believed that khat poses certain health risks, just as anything does in excess. It certainly has the potential for dependence – this has been demonstrated. In rare cases it’s been linked with liver failure, and heart disease, and – in slightly less rare cases – with oral cancers. Its mortality rate is still, in the scheme of things, extraordinarily low: Tobacco and alcohol remain riskier by an enormous degree. But, if we’re honest, it probably isn’t entirely benign.

We don’t ban alcohol and tobacco, and the Government has always shied away from explicitly stating why, but presumably it is because these are historical Western institutions, protected like a religious right, and the prospect of getting rid of them is intimidating. There would be an uproar, outcries, probably rioting. It is acknowledged that these substances are a part of our culture, for better or for worse – so we gently discourage their over-use, while still utilising them to generate huge sums of money for the tax man.

Khat isn’t as popular here. It’s rarely used by British people, who prefer to get their equivalent fix from coffee or Coca-Cola. There is not a mass market for this product, so it can’t be used as a financial buffer, and the number of people who would be incensed by its ban are relatively small in these lands.

But the fact remains that certain communities within our country are now being told that the thing they have done for hundreds if not thousands of years, for generation after generation, is no longer permitted. The worrying effect of all this is that communities that have been using this substance for as long as people can remember, many of whom are addicted to it, are suddenly being robbed of their fix. There has been no mention of any support systems being set up, but May has been quick to point out the risks of the UK being used as a hub for khat trafficking to countries where it is already illegal, its use allegedly – but as yet unprovenly – being used to find terrorism. These are troubling parallels to draw.

And this is happening even though the experts in the AMDC overwhelmingly agreed that it should remain legal. Even though they said there has been no evidence, across decades of research, to suggest that khat poses a significant enough societal or medical risk to become a classified substance. Even though they have suggested integrating with these communities to arrive at mutually agreeable solutions to the problem. Even though they are the experts, advising the law-makers. Nope, say the law-makers. We don’t agree with you. We think you are wrong.

Here’s an idea: maybe they’re not wrong. Maybe, when you get experts in, who year after year tell you that you are doing things incorrectly, you should start to listen. Maybe, when you sack people for disagreeing with you, and their replacements continue to disagree with you, some alarm bells might start to ring.

Or maybe, just maybe, the AMDC functions as a convenient public relations department: a useless filtering system that nevertheless shows that the Government is doing something to understand the real issues behind our substance dependency problems. Look, they spoke to experts! They’re doing things by the book! Except no, they’re not. Because this isn’t how it works at all.

When the Government proposed a Class-A restriction on psylocibin mushrooms, it approached the AMDC with far too little time to produce a full report. According to Nutt, the Government had already made up its mind. Provisionally the Council told the Government that it was very unlikely that they would recommend magic mushrooms should be made Class A. The Government, he alleges, thanked them for their time, then immediately passed legislature that made them among the most illegal things to have on your person.

The AMDC is not a board of experts to be consulted. The AMDC is a board of experts whom the Government hopes will give weight to the decisions they have already made. But, as drug after drug is banned against the Council’s recommendations, to less of an uproar and more of a mild groan, but in ways that could seriously damage certain migrant communities within our proudly multicultural nation, one has to wonder: when will people really sit up and pay attention?

We hope there will be close attention paid to the ACMD‘s further recommendations, which all have our unanimous support. It is essential that communities be supported and given the appropriate resource and environment within which they can manage issues e.g. to support integration and address inequalities of health … Our recommendations are based on a rigorous and systematic process of evidence gathering and subsequent analysis of what was submitted and presented to the ACMD. We would welcome discussing our findings with you.

Khat: A review of its potential harms to the individual and socities within the UK
The Advisory Council on the Misuse of Drugs, January 2013

All things considered, I have quite the history with knees. I remember, as a child, my dad being in and out of the doctor’s office with persistent knee problems, initially caused by a ligament injury and subsequently aggravated by various things. I remember him in knee braces, in hospital for arthroscopic surgeries, and sprawled out on the ground in our garden after running to answer the phone. My dad’s knee was just something that went wrong in our lives sometimes.

Fast-forward a few years and I remember the first time I injured myself in such a way that the pain lingered for more than a few minutes. Messing around with a friend in PE (I was about 11, I think), I hyperextended my left leg while weight-bearing. Cue two days of being unable to walk. And fast-forward again to being 18, when, while in a nightclub, I slipped on a spilled drink, resulting in a night in A&E with a dislocated patella. This was a particularly nasty one. Six weeks in a full leg splint, about a month more on crutches, and a further two or three months in fairly intensive physiotherapy. It was a time in my life that taught me quite how much we rely on mobile knees. Next time you need the loo (number 2), try going through the whole process without bending your right knee whatsoever.

I’ve never tried to kill myself. I’ve suffered from depression and I used to self-harm, but I guess that’s true of a lot of people. I also didn’t know games journalist Matt Hughes, who sadly died this week, even slightly. I barely even recognised the name. I had to check who he wrote for. Seems he was a talented guy, not that that makes a difference.

When people commit suicide, people’s response is generally to gasp at how there were no warning signs, that it doesn’t make sense, that the person always seemed so happy. “He was full of life,” people say. “It’s just so out of character.”

When people kill themselves, they’re not doing so out of character. They do it because they’ve exhausted every other option they can possibly comprehend, and things have become so overwhelming that putting a stop to everything now is the only sensible option, for everyone’s sake.

You could say that the main symptom of depression is a feeling of remarkable sadness, but it’s more than that. It’s a feeling of isolation. A feeling of self-loathing. A sense that you’ll never have the ability to separate yourself from the ills of the world, and as such will never be able to construct a coping mechanism or reason yourself out of a low mood with logic.

And it’s a feeling that you’re all alone in this world; those healthy, happy masses go about their daily lives with barely a stumble, while every single split-second of your own life is a hammer-blow to the head. Those people don’t care. Why should they? If they cared, and let themselves into your mind, they’d be depressed too.

The truth is, nobody really takes the time to think about what goes on in the minds of others. Not really. We all have our own lives to lead, and that’s difficult enough as it is. But I like to think that, as people, as the human race, we do care. Even just a little bit.

I’m one of the lucky ones. I’m mostly okay now, aside from the occasional off-day. I put a lot of that down to my re-discovery of writing, and my decision to apply myself to a goal. But I also put a lot of it down to the fact that I had people who really took the time to understand how I was feeling.

When was the last time you asked somebody if they were okay and really meant it? We say it trivially every time we meet someone, and the correct response is, “I’m fine, thanks. How are you?” You must not deviate from the script. To do so is social suicide. If you’ll excuse the metaphor.

But really, we’re all human, and we all get sad sometimes, and we all ultimately care when we find out that other people are suffering. So the next time you see your friend, ask them if they’re okay. Really ask it, and push them for a real answer. They’re probably fine. But it might just turn out that your friend needs an ear, and they’ll be grateful for that question for the rest of their life.

And if they think you’re being weird, or take the mick out of you, then they’re a cunt.

The Guardian and Mixmag have done something quite incredible: a survey about drug use, conducted on an absolutely enormous scale, that gives phenomenal insight into the reasons people take drugs, and those people’s thoughts about their substance intake.

The spectacular range of results have been recorded in a smart, measured and balanced fashion all over The Guardian’s website, and will presumably be featured heavily in the paper tomorrow.

It’s quite an astonishing set of articles to read. There are some frightening findings, and some comforting ones. Quite predictably, it turns out there are some people who take drugs in moderation and with knowledge, and are fine, and there are others who don’t, and aren’t. The crucial thing is that this isn’t just hearsay any more.